Service of Infectious Diseases, Geneva University Hospitals & Medical School, Geneva, Switzerland.
J Infect. 2012 May;64(5):513-9. doi: 10.1016/j.jinf.2011.12.023. Epub 2012 Feb 1.
Previous skin carriage of methicillin-resistant Staphylococcus aureus (MRSA) leads frequently to empiric antibiotic MRSA coverage for skin & soft tissue infections.
Retrospective cohort study of orthopaedic patients hospitalized at Geneva University Hospitals (MRSA prevalence; 30%); community-acquired MRSA excluded.
A total of 378 skin and soft tissue infections in 346 patients were retrieved. Overall cure was achieved in 330 episodes (87%) after a median antibiotic administration of 15 days. Among all episodes, 102 revealed a positive current MRSA status (during 2 weeks preceding infection; 27%) and 70 (19%) were MRSA carriers in the past. Sensitivity, specificity, positive and negative predictive values of current MRSA skin carriage to predict abscesses due to MRSA were 0.68, 0.77, 0.19, and 0.97, respectively. Fifty-four current MRSA carriers (54/102, 53%) and 30 past carriers (43%) were successfully treated with a non-MRSA antibiotic agent. In multivariate Cox regression analysis, anti-MRSA coverage (hazard ratio 1.2, 95%CI 0.5-2.8) and duration of antibiotic therapy (HR 1.0, 95%CI 0.96-1.02) did not influence treatment failure among patients with positive MRSA carriage.
Current or past HA-MRSA skin carriage poorly predicts the need for anti-MRSA coverage for the antibiotic treatment of skin and soft tissue infections in hospitalized orthopaedic patients.
耐甲氧西林金黄色葡萄球菌（MRSA）的既往皮肤携带率常导致经验性抗生素治疗 MRSA 覆盖皮肤和软组织感染。
对日内瓦大学医院（MRSA 流行率为 30%）住院骨科患者进行回顾性队列研究；排除社区获得性 MRSA。
共检索到 346 例患者 378 例皮肤和软组织感染。中位抗生素治疗 15 天后，330 例（87%）获得总体治愈。所有感染中，102 例显示当前 MRSA 状态阳性（感染前 2 周；27%），70 例（19%）既往为 MRSA 携带者。当前 MRSA 皮肤携带预测由 MRSA 引起脓肿的敏感性、特异性、阳性和阴性预测值分别为 0.68、0.77、0.19 和 0.97。54 名当前 MRSA 携带者（54/102，53%）和 30 名既往携带者（43%）成功接受非 MRSA 抗生素治疗。多变量 Cox 回归分析显示，抗-MRSA 覆盖（风险比 1.2，95%CI 0.5-2.8）和抗生素治疗持续时间（HR 1.0，95%CI 0.96-1.02）并未影响阳性 MRSA 携带患者的治疗失败。
当前或既往 HA-MRSA 皮肤携带率对住院骨科患者皮肤和软组织感染抗生素治疗中抗-MRSA 覆盖的需求预测不佳。
